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A 90 year old woman in a nursing home is not spreading COVID. Wouldn't it make more sense to give this to people who are most at risk of spreading it, not dying

A 90 year old woman in a nursing home is not spreading COVID. Wouldn't it make more sense to give this to people who are most at risk of spreading it, not dying from it? Why wouldn't we go at the root cause of the pandemic; young healthy asymptomatic spreaders?

robotfelix 6y ago
While I would certainly hope that it prevents spread too, I believe that the vaccine is only proven to prevent Covid-19 (the disease), and not to prevent the spread of SARS-CoV-2 (the virus that causes it).
dbbk 6y ago
The vaccine isn't proven to prevent spread.
nojito 6y ago
Because stopping the elderly from overwhelming the health infrastructure needs to be step 1. ICU beds are extremely expensive.
- oxfordmale 6y ago
  At this age, you don't get admitted to an ICU bed
  - nobrains 6y ago
    No, you do, because no matter the age, the family members still want to have a chance of survival of their loved one. My distant relative (70 year old) was in ICU for 30 days, and on ventilator for 14 days. Yes, that is a very long time for ventilator usage, and every day more on a ventilator increases the death rate probability percentage.
    - oxfordmale 6y ago
      At the age of 90, your lungs are too fragile to be put on a ventilator. It was one of the reasons academics overestimated the number of ventilators required for COVID.
      - lagadu 6y ago
        Too fragile for a ventilator but not too fragile for ecmo.
      - exdsq 6y ago
        This isn't a hard-set rule, just an extra factor in triage Edit: Do you work at the JR by any chance? Asking as another Oxford Male based nearby! https://academic.oup.com/biomedgerontology/article/60/1/129/533726 https://academic.oup.com/biomedgerontology/article/60/1/129/...
      - KaiserPro 6y ago
        its really not that simple, it turned out that the stats we were working from were wrong (well done china...) but also ventilators are not great for covid patients. Its much better to slap them with oxygen.
  - Narretz 6y ago
    Of course they do, as long as there's a bed available. Especially with Covid. No hospital wants to be the one that denied a patient an available ICU bed.
    - djhn 6y ago
      Well at the NHS they'd consider your approach American Overtreatment.
      - KaiserPro 6y ago
        [citation needed] Do you work in a hospital? do you know any ICU people? I think you are confusing palliative care with ICU American overtreatment is busting out MRIs for a standard sprain, routine CAT scans, dishing out opiates for anything more than 2weeks
  - deleted 6y ago
    [deleted]
- redis_mlc 6y ago
  US Corona ICU survivors are being sent bills averaging $1 million. Of course, 80-90% of those didn't make it.
- raxxorrax 6y ago
  The price is one thing, but after ICU you need to train to breath again, it takes a very long rehabilitation time. It is a very invasive method of keeping someone alive and is only used in emergencies. Rehabilitation also binds resources.
  - ChrisRR 6y ago
    Ventilator weaning is a long process
andyjohnson0 6y ago
It's not yet known whether the Pfizer vaccine prevents an infected person from transmitting the infection to other people [1]. But there is robust evidence that is does prevent an immunised person from becoming ill. [1] https://www.nature.com/articles/d41586-020-03441-8 https://www.nature.com/articles/d41586-020-03441-8
- sleepyshift 6y ago
  Could someone please explain how this can be the case? I understand the vaccine works by stimulating antibody production, which prevent you from becoming ill by binding to the virus and disabling it should it enter your system. How then could the virus be spread further if it's already been disabled?
  - doovd 6y ago
    You are asking why an already infected person who receives the vaccine may still be able to spread it? The virus is still able to spread while the body fights it. In fact I'm not even sure there is a significant advantage of giving the vaccine to someone who already has the virus (as after all the vaccine teaches the body what the virus looks like and therefore how it can be tackled). This specific vaccine looks as if it simulates certain aspects of the virus, therefore not entirely necessary for someone who already has the virus I believe. But yeah - it's not like you get jabbed and you have instant immunity. Your body needs to learn to fight it, and then actually fight it - and if you already have it you are still infectious during this period.
  - throwawaycovi5 6y ago
    The vaccine teaches your immune system to respond to a particular protein that surrounds the virus. If you contract the virus you are still infectious until it can kill all of the virus. The time between the immune response and OG infection can mean the virus has time to replicate and spread/ be shed I’m guessing.
  - kmm 6y ago
    Different tissues are protected by different types of antibodies. A vaccine injected subcutaneously will mostly induce an IgG response, a type of antibody present in blood and extracellular fluid. This could still possibly allow a virus to infect mucous membranes, which rely on a different type of antibody, sIgA[0], to protect them. If this is the case, you could be protected from having a serious systemic infection, but could still suffer a mild upper respiratory infection, and be infectious until the immune system mounted defense in the mucous membranes. Some flu vaccines come in the form of a nasal spray, which does induce an IgA response. I don't know why COVID vaccines are administered parenterally instead, I'm sure there are good technical reasons. Given the virus's possible neurological involvement, maybe it's a bad idea to deposit it so close to the olfactory bulb. 0: https://en.wikipedia.org/wiki/Immunoglobulin_A#Secretory_IgA https://en.wikipedia.org/wiki/Immunoglobulin_A#Secretory_IgA
JonoW 6y ago
I believe the vaccine has not been showed to reduce transmission, it's been shown to reduce impact, i.e. she's less likely to die if someone visits her, so great for her, and her families, well-being.
- cpfohl 6y ago
  Not just less likely: no one who got the vaccine in trials has died (of COVID)
- Narretz 6y ago
  If it reduces impact it also reduces impact of transmission because the patient has lower viral load. Masks have to same effect, although to a lesser degree (and obviously a different mode of operation).
  - M2Ys4U 6y ago
    >If it reduces impact it also reduces impact of transmission because the patient has lower viral load. That's incredibly likely but it's not what the trails tested, and so we can't rely on it. When the vaccine has been rolled out much more widely we'll be able to gather the data to test that hypothesis using surveillance data.
Wintamute 6y ago
Just as a side note, asymptomatic spread is a contested topic. If asymptomatic spread were a major driver of infection, this would be the first respiratory virus to work that way. Sources: - Nature study, 20th Nov https://www.nature.com/articles/s41467-020-19802-w https://www.nature.com/articles/s41467-020-19802-w - Maria Van Kerkhove, head of the WHO Emerging Diseases and Zoonosis unit https://www.youtube.com/watch?v=NQTBlbx1Xjs https://www.youtube.com/watch?v=NQTBlbx1Xjs - Fauci in 2018 https://www.youtube.com/watch?v=vrAvjU2LBkg&feature=emb_title https://www.youtube.com/watch?v=vrAvjU2LBkg&feature=emb_titl...
- madeofpalk 6y ago
  My casual understanding was that there werent really any asymptomatic spreaders, just "not symptomatic yet". Is this wrong?
  - Wintamute 6y ago
    I'm not aware of stats relating to how many asymptomatic individuals go on to develop full blown symptomatic Covid-19. My assumption is that testing PCR positive while remaining asymptomatic the entire time is by far the most common experience. Of course, whether you go on to develop symptoms or not, its still highly pertinent information if asymptomatic spread is not a major driver of infection. As long as you self isolate upon symptom onset that should be enough. It does call into question whether isolating the apparently healthy is an evidence-based public health policy intervention though.
    - doliveira 6y ago
      Asymptomatic individuals never develop any symptoms. And the viral load is high two days before the symptoms onset. If you want a proper RCT about it, good luck approving it in an ethics committee.
    - AlanSE 6y ago
      Truly asymptomatic spread is not a major driver of infection. There are been some major public relations problems when an organization said this, and were mistaken to mean pre-symptomatic, but the science is pretty clear. We used to think true asymptomatic infections (never develop any symptoms but test positive) were ~50% of those infected. More recent research puts it at closer to ~20%. Again, some reporting bungled this by reporting studies from controlled populations (like a cruise ship) before they knew if cases were asymptomatic or pre-symptomatic, causing people to quote the number as the former, when it was really a mix. COVID spreads like wildfire by pre-symptomatic people. There are mountains of evidence to support this. Spread by asymptomatic people is speculation. > Of course, whether you go on to develop symptoms or not, its still highly pertinent information if asymptomatic spread is not a major driver of infection. Not sure, but I think you may be using the word "asymptomatic" to denote pre-symptomatic in this sentence. > As long as you self isolate upon symptom onset that should be enough. It is not enough.
iso1631 6y ago
They looked at that, and modelled what would save the most life-years based on limited speed that the vaccine can be deployed, how well the vaccine works in stopping bad effects (i.e. death), and how well it works in stopping spread. > JCVI has considered a number of different vaccination strategies, including those targeting transmission and those targeted at providing direct protection to persons most at risk. In order to interrupt transmission, mathematical modelling indicates that we would need to vaccinate a large proportion of the population with a vaccine which is highly effective at preventing infection (transmission). At the start of the vaccination programme, good evidence on the effects of vaccination on transmission will not be available, and vaccine availability will be more limited. The best use of available vaccine will also, in part, be dependent on the point in the pandemic the UK is at. Given the current epidemiological situation in the UK, all evidence indicates that the best option for preventing morbidity and mortality in the initial phase of the programme is to directly protect persons most at risk of morbidity and mortality. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/940936/Priority_groups_for_coronavirus__COVID-19__vaccination_-_advice_from_the_JCVI__2_December_2020.pdf https://assets.publishing.service.gov.uk/government/uploads/...
Narretz 6y ago
Why not? She could contract it from a caretaker or visitor, and then spread it to the next caretaker who spreads it further. One advantage of immunization in nursing homes is also that they can now take visitors more liberally.
tzs 6y ago
1. Most nursing homes have more than one elderly resident, living in close contact. Your 90 year old woman can spread it to them. 2. By what mechanism do you imagine it got into the nursing home without that mechanism also working to spread it to outside?
KaiserPro 6y ago
You are not looking at the whole picture here. The uk is vaccinating according to risk of death, and risk of occupying a hospital bed first. Not the risk of catching or passing it. THe big concern in this pandemic has been hospital usage. once your hospital is full everyone starts dying not just covid patients. We were about two/four weeks away from collapse in london in april.
- throwaway2245 6y ago
  As a standard, the UK makes medical decisions based on QALYs saved (quality-adjusted life years). Although you can argue that keeping hospital beds free saves a lot of QALYs, it's harder to argue that care homes have a lot of QALYs to save. And, it's not obvious that care home patients are the first to occupy hospital beds (I'm unsure about it); care home patients with COVID have tended to die in their care home.
  - hn_throwaway_99 6y ago
    > it's harder to argue that care homes have a lot of QALYs to save. Not true at all. They may have fewer life years left, but they're orders of magnitude more likely to die from Covid, so preventing a Covid case in this population actually saves more QALYs than preventing a case in a younger healthy person, statistically speaking.
stevehawk 6y ago
isn't this where most of the fatalities are happening? isnt the handling of elderly covid patients the reason a lot of people are unhappy with Cuomo and others because they turned retirement homes into morgues?
- foota 6y ago
  I believe this was the case at the start, I'm not sure if this is the case now however. Deaths have only recently arrived at where they were at the first peak in the US, my impression was this was because it was a less vulnerable population being infected.
hestefisk 6y ago
I’m sure the infectious disease specialists know what they are doing.
- jfengel 6y ago
  I wouldn't go that far. But I'd say they're doing their best with what they do know, which is going to be more comprehensive than "some guy on the Internet". It doesn't mean they're right, or even that they're all in agreement on the best course. But they're tasked with making a decision that absolutely has to be made right now, and can't wait on getting a complete picture.
sjwright 6y ago
> Wouldn't it make more sense to give this to people who are most at risk of spreading it, not dying from it? No, it makes sense to give this to people who are most at risk of spreading it to people who are most at risk of dying from it. Thus anyone in and around aged care.
krona 6y ago
1. Relative risk 2. The study of the vaccine thus far evaluated immunity, not transmission; not the same thing. 3. A 90 year old is far more likely to die of the virus regardless of whether she is infectious.
zaarn 6y ago
Vaccination also prevents catching it, which prevents dying from it, which this age group is much at risk at even without prior complications. There is a heck of a lot more people who are at risk of being superspreaders, not even mentioning the huge number of middle aged people going to protests against a diseases existence. You won't get those people vaccinated. They will massively contribute to the spread. Additionally, vaccinating risk groups in the high age category first lets you spot complications with the disease more early and it's ethically somewhat better to risk long-term vaccination issues with 90+ year olds than 20+ year olds, as one of these groups will have to suffer the consequences for a shorter time. It may sound harsh to make comparisons like that but you'll have to make decisions like that in a medical environment.
astura 6y ago
The vaccine wasn't tested for reducing spread - it was only tested for preventing symptomatic illness. We don't know yet if vaccinated people exposed to covid can spread it to others even if they don't get sick. Therefore we base our vaccination protocols on something the vaccine is proven to do, not something it might do hypothetically.
deleted 6y ago
[deleted]
tyingq 6y ago
Anecdotal, but several "super spread" type events near me were nursing homes. Makes some sense as there are a lot of communal facilities. People cross paths a lot, and several shifts of employees are in and out.
dis-sys 6y ago
because the vaccine has never been proven to be able to stop asymptomatic spreads.
mcky 6y ago
I wouldn't be surprised if there was a small political motivation here too - the gov were heavily criticized for their terrible handling of covid in care homes, with an older voter base they might want to be seen to be doing right by the care homes this time around
- hn_throwaway_99 6y ago
  Nonsense. Every country I've heard about is prioritizing nursing home residents, and few of them received the level of criticism that the UK did regarding nursing home residents.
- altacc 6y ago
  I think there is an understandable political element to this, in that people want to see a reduction in the death rate from Covid-19 and politicians are judged on the number of deaths. So vaccinating those most likely to die makes perfect sense as it'll have most impact on death rates and therefore politicians' reputations.
nojito 6y ago
The first phase isn't to stop the spread. The initial pool of vaccinations is to lower the strain on healthcare infrastructure. Older patients are at more risk of requiring hospital stays + ICU stays.
whoomp12342 6y ago
yeah but how do you find those people without a massive civil rights violation?
Jemm 6y ago
The person administering the vaccine while not wearing gloves for instance?
jnet 6y ago
"Wouldn't it make more sense to give this to people who are most at risk of spreading it, not dying from it?" It wouldn't make any sense at all. The reason is that not only do older people have a greater risk of dying from Covid, they also have a much higher risk of being hospitalized[1], and remember the justification for the extreme measures we've taken and continue to take is the fear we will overwhelm our health care systems. [1] https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-age.html https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investi...
jariel 6y ago
People in homes are possibly primary vectors of spread, especially during the early days because they catch it so easily and are around others who catch it easily. Also, the workers in the homes are put at significant risk due to this as well.

robotfelix 6y ago

While I would certainly hope that it prevents spread too, I believe that the vaccine is only proven to prevent Covid-19 (the disease), and not to prevent the spread of SARS-CoV-2 (the virus that causes it).

dbbk 6y ago

The vaccine isn't proven to prevent spread.

nojito 6y ago

Because stopping the elderly from overwhelming the health infrastructure needs to be step 1. ICU beds are extremely expensive.

oxfordmale 6y ago
At this age, you don't get admitted to an ICU bed
- nobrains 6y ago
  No, you do, because no matter the age, the family members still want to have a chance of survival of their loved one. My distant relative (70 year old) was in ICU for 30 days, and on ventilator for 14 days. Yes, that is a very long time for ventilator usage, and every day more on a ventilator increases the death rate probability percentage.
  - oxfordmale 6y ago
    At the age of 90, your lungs are too fragile to be put on a ventilator. It was one of the reasons academics overestimated the number of ventilators required for COVID.
    - lagadu 6y ago
      Too fragile for a ventilator but not too fragile for ecmo.
    - exdsq 6y ago
      This isn't a hard-set rule, just an extra factor in triage Edit: Do you work at the JR by any chance? Asking as another Oxford Male based nearby! https://academic.oup.com/biomedgerontology/article/60/1/129/533726 https://academic.oup.com/biomedgerontology/article/60/1/129/...
    - KaiserPro 6y ago
      its really not that simple, it turned out that the stats we were working from were wrong (well done china...) but also ventilators are not great for covid patients. Its much better to slap them with oxygen.
- Narretz 6y ago
  Of course they do, as long as there's a bed available. Especially with Covid. No hospital wants to be the one that denied a patient an available ICU bed.
  - djhn 6y ago
    Well at the NHS they'd consider your approach American Overtreatment.
    - KaiserPro 6y ago
      [citation needed] Do you work in a hospital? do you know any ICU people? I think you are confusing palliative care with ICU American overtreatment is busting out MRIs for a standard sprain, routine CAT scans, dishing out opiates for anything more than 2weeks
- deleted 6y ago
  [deleted]
redis_mlc 6y ago
US Corona ICU survivors are being sent bills averaging $1 million. Of course, 80-90% of those didn't make it.
raxxorrax 6y ago
The price is one thing, but after ICU you need to train to breath again, it takes a very long rehabilitation time. It is a very invasive method of keeping someone alive and is only used in emergencies. Rehabilitation also binds resources.
- ChrisRR 6y ago
  Ventilator weaning is a long process

andyjohnson0 6y ago

It's not yet known whether the Pfizer vaccine prevents an infected person from transmitting the infection to other people [1]. But there is robust evidence that is does prevent an immunised person from becoming ill. [1] https://www.nature.com/articles/d41586-020-03441-8 https://www.nature.com/articles/d41586-020-03441-8

sleepyshift 6y ago
Could someone please explain how this can be the case? I understand the vaccine works by stimulating antibody production, which prevent you from becoming ill by binding to the virus and disabling it should it enter your system. How then could the virus be spread further if it's already been disabled?
- doovd 6y ago
  You are asking why an already infected person who receives the vaccine may still be able to spread it? The virus is still able to spread while the body fights it. In fact I'm not even sure there is a significant advantage of giving the vaccine to someone who already has the virus (as after all the vaccine teaches the body what the virus looks like and therefore how it can be tackled). This specific vaccine looks as if it simulates certain aspects of the virus, therefore not entirely necessary for someone who already has the virus I believe. But yeah - it's not like you get jabbed and you have instant immunity. Your body needs to learn to fight it, and then actually fight it - and if you already have it you are still infectious during this period.
- throwawaycovi5 6y ago
  The vaccine teaches your immune system to respond to a particular protein that surrounds the virus. If you contract the virus you are still infectious until it can kill all of the virus. The time between the immune response and OG infection can mean the virus has time to replicate and spread/ be shed I’m guessing.
- kmm 6y ago
  Different tissues are protected by different types of antibodies. A vaccine injected subcutaneously will mostly induce an IgG response, a type of antibody present in blood and extracellular fluid. This could still possibly allow a virus to infect mucous membranes, which rely on a different type of antibody, sIgA[0], to protect them. If this is the case, you could be protected from having a serious systemic infection, but could still suffer a mild upper respiratory infection, and be infectious until the immune system mounted defense in the mucous membranes. Some flu vaccines come in the form of a nasal spray, which does induce an IgA response. I don't know why COVID vaccines are administered parenterally instead, I'm sure there are good technical reasons. Given the virus's possible neurological involvement, maybe it's a bad idea to deposit it so close to the olfactory bulb. 0: https://en.wikipedia.org/wiki/Immunoglobulin_A#Secretory_IgA https://en.wikipedia.org/wiki/Immunoglobulin_A#Secretory_IgA

JonoW 6y ago

I believe the vaccine has not been showed to reduce transmission, it's been shown to reduce impact, i.e. she's less likely to die if someone visits her, so great for her, and her families, well-being.

cpfohl 6y ago
Not just less likely: no one who got the vaccine in trials has died (of COVID)
Narretz 6y ago
If it reduces impact it also reduces impact of transmission because the patient has lower viral load. Masks have to same effect, although to a lesser degree (and obviously a different mode of operation).
- M2Ys4U 6y ago
  >If it reduces impact it also reduces impact of transmission because the patient has lower viral load. That's incredibly likely but it's not what the trails tested, and so we can't rely on it. When the vaccine has been rolled out much more widely we'll be able to gather the data to test that hypothesis using surveillance data.

Wintamute 6y ago

Just as a side note, asymptomatic spread is a contested topic. If asymptomatic spread were a major driver of infection, this would be the first respiratory virus to work that way. Sources: - Nature study, 20th Nov https://www.nature.com/articles/s41467-020-19802-w https://www.nature.com/articles/s41467-020-19802-w - Maria Van Kerkhove, head of the WHO Emerging Diseases and Zoonosis unit https://www.youtube.com/watch?v=NQTBlbx1Xjs https://www.youtube.com/watch?v=NQTBlbx1Xjs - Fauci in 2018 https://www.youtube.com/watch?v=vrAvjU2LBkg&feature=emb_title https://www.youtube.com/watch?v=vrAvjU2LBkg&feature=emb_titl...

madeofpalk 6y ago
My casual understanding was that there werent really any asymptomatic spreaders, just "not symptomatic yet". Is this wrong?
- Wintamute 6y ago
  I'm not aware of stats relating to how many asymptomatic individuals go on to develop full blown symptomatic Covid-19. My assumption is that testing PCR positive while remaining asymptomatic the entire time is by far the most common experience. Of course, whether you go on to develop symptoms or not, its still highly pertinent information if asymptomatic spread is not a major driver of infection. As long as you self isolate upon symptom onset that should be enough. It does call into question whether isolating the apparently healthy is an evidence-based public health policy intervention though.
  - doliveira 6y ago
    Asymptomatic individuals never develop any symptoms. And the viral load is high two days before the symptoms onset. If you want a proper RCT about it, good luck approving it in an ethics committee.
  - AlanSE 6y ago
    Truly asymptomatic spread is not a major driver of infection. There are been some major public relations problems when an organization said this, and were mistaken to mean pre-symptomatic, but the science is pretty clear. We used to think true asymptomatic infections (never develop any symptoms but test positive) were ~50% of those infected. More recent research puts it at closer to ~20%. Again, some reporting bungled this by reporting studies from controlled populations (like a cruise ship) before they knew if cases were asymptomatic or pre-symptomatic, causing people to quote the number as the former, when it was really a mix. COVID spreads like wildfire by pre-symptomatic people. There are mountains of evidence to support this. Spread by asymptomatic people is speculation. > Of course, whether you go on to develop symptoms or not, its still highly pertinent information if asymptomatic spread is not a major driver of infection. Not sure, but I think you may be using the word "asymptomatic" to denote pre-symptomatic in this sentence. > As long as you self isolate upon symptom onset that should be enough. It is not enough.

iso1631 6y ago

They looked at that, and modelled what would save the most life-years based on limited speed that the vaccine can be deployed, how well the vaccine works in stopping bad effects (i.e. death), and how well it works in stopping spread. > JCVI has considered a number of different vaccination strategies, including those targeting transmission and those targeted at providing direct protection to persons most at risk. In order to interrupt transmission, mathematical modelling indicates that we would need to vaccinate a large proportion of the population with a vaccine which is highly effective at preventing infection (transmission). At the start of the vaccination programme, good evidence on the effects of vaccination on transmission will not be available, and vaccine availability will be more limited. The best use of available vaccine will also, in part, be dependent on the point in the pandemic the UK is at. Given the current epidemiological situation in the UK, all evidence indicates that the best option for preventing morbidity and mortality in the initial phase of the programme is to directly protect persons most at risk of morbidity and mortality. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/940936/Priority_groups_for_coronavirus__COVID-19__vaccination_-_advice_from_the_JCVI__2_December_2020.pdf https://assets.publishing.service.gov.uk/government/uploads/...

Narretz 6y ago

Why not? She could contract it from a caretaker or visitor, and then spread it to the next caretaker who spreads it further. One advantage of immunization in nursing homes is also that they can now take visitors more liberally.

tzs 6y ago

1. Most nursing homes have more than one elderly resident, living in close contact. Your 90 year old woman can spread it to them. 2. By what mechanism do you imagine it got into the nursing home without that mechanism also working to spread it to outside?

KaiserPro 6y ago

You are not looking at the whole picture here. The uk is vaccinating according to risk of death, and risk of occupying a hospital bed first. Not the risk of catching or passing it. THe big concern in this pandemic has been hospital usage. once your hospital is full everyone starts dying not just covid patients. We were about two/four weeks away from collapse in london in april.

throwaway2245 6y ago
As a standard, the UK makes medical decisions based on QALYs saved (quality-adjusted life years). Although you can argue that keeping hospital beds free saves a lot of QALYs, it's harder to argue that care homes have a lot of QALYs to save. And, it's not obvious that care home patients are the first to occupy hospital beds (I'm unsure about it); care home patients with COVID have tended to die in their care home.
- hn_throwaway_99 6y ago
  > it's harder to argue that care homes have a lot of QALYs to save. Not true at all. They may have fewer life years left, but they're orders of magnitude more likely to die from Covid, so preventing a Covid case in this population actually saves more QALYs than preventing a case in a younger healthy person, statistically speaking.

stevehawk 6y ago

isn't this where most of the fatalities are happening? isnt the handling of elderly covid patients the reason a lot of people are unhappy with Cuomo and others because they turned retirement homes into morgues?

foota 6y ago
I believe this was the case at the start, I'm not sure if this is the case now however. Deaths have only recently arrived at where they were at the first peak in the US, my impression was this was because it was a less vulnerable population being infected.

hestefisk 6y ago

I’m sure the infectious disease specialists know what they are doing.

jfengel 6y ago
I wouldn't go that far. But I'd say they're doing their best with what they do know, which is going to be more comprehensive than "some guy on the Internet". It doesn't mean they're right, or even that they're all in agreement on the best course. But they're tasked with making a decision that absolutely has to be made right now, and can't wait on getting a complete picture.

sjwright 6y ago

> Wouldn't it make more sense to give this to people who are most at risk of spreading it, not dying from it? No, it makes sense to give this to people who are most at risk of spreading it to people who are most at risk of dying from it. Thus anyone in and around aged care.

krona 6y ago

1. Relative risk 2. The study of the vaccine thus far evaluated immunity, not transmission; not the same thing. 3. A 90 year old is far more likely to die of the virus regardless of whether she is infectious.

zaarn 6y ago

Vaccination also prevents catching it, which prevents dying from it, which this age group is much at risk at even without prior complications. There is a heck of a lot more people who are at risk of being superspreaders, not even mentioning the huge number of middle aged people going to protests against a diseases existence. You won't get those people vaccinated. They will massively contribute to the spread. Additionally, vaccinating risk groups in the high age category first lets you spot complications with the disease more early and it's ethically somewhat better to risk long-term vaccination issues with 90+ year olds than 20+ year olds, as one of these groups will have to suffer the consequences for a shorter time. It may sound harsh to make comparisons like that but you'll have to make decisions like that in a medical environment.

astura 6y ago

The vaccine wasn't tested for reducing spread - it was only tested for preventing symptomatic illness. We don't know yet if vaccinated people exposed to covid can spread it to others even if they don't get sick. Therefore we base our vaccination protocols on something the vaccine is proven to do, not something it might do hypothetically.

deleted 6y ago

[deleted]

tyingq 6y ago

Anecdotal, but several "super spread" type events near me were nursing homes. Makes some sense as there are a lot of communal facilities. People cross paths a lot, and several shifts of employees are in and out.

dis-sys 6y ago

because the vaccine has never been proven to be able to stop asymptomatic spreads.

mcky 6y ago

I wouldn't be surprised if there was a small political motivation here too - the gov were heavily criticized for their terrible handling of covid in care homes, with an older voter base they might want to be seen to be doing right by the care homes this time around

hn_throwaway_99 6y ago
Nonsense. Every country I've heard about is prioritizing nursing home residents, and few of them received the level of criticism that the UK did regarding nursing home residents.
altacc 6y ago
I think there is an understandable political element to this, in that people want to see a reduction in the death rate from Covid-19 and politicians are judged on the number of deaths. So vaccinating those most likely to die makes perfect sense as it'll have most impact on death rates and therefore politicians' reputations.

nojito 6y ago

The first phase isn't to stop the spread. The initial pool of vaccinations is to lower the strain on healthcare infrastructure. Older patients are at more risk of requiring hospital stays + ICU stays.

whoomp12342 6y ago

yeah but how do you find those people without a massive civil rights violation?

Jemm 6y ago

The person administering the vaccine while not wearing gloves for instance?

jnet 6y ago

"Wouldn't it make more sense to give this to people who are most at risk of spreading it, not dying from it?" It wouldn't make any sense at all. The reason is that not only do older people have a greater risk of dying from Covid, they also have a much higher risk of being hospitalized[1], and remember the justification for the extreme measures we've taken and continue to take is the fear we will overwhelm our health care systems. [1] https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-age.html https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investi...

jariel 6y ago

People in homes are possibly primary vectors of spread, especially during the early days because they catch it so easily and are around others who catch it easily. Also, the workers in the homes are put at significant risk due to this as well.